Building Resilient and Sustainable Communities Using a Robust Theory of Change

Introduction

The recent disruptions in USAID funding have left many organizations grappling with uncertainty, restructuring, and even closure. While this presents challenges for implementing partners, the most critical question remains: What happens to the people who relied on these interventions?

One of the sectors most impacted by these disruptions is health programming, raising concerns about access to quality healthcare for vulnerable populations. This situation underscores the need for organizations to rethink sustainability within their Theory of Change (ToC)—ensuring that communities continue to benefit long after donor funding ends.

The Role of a Theory of Change (ToC) in Building Sustainability

A Theory of Change (ToC) is not just a framework for achieving outcomes; it is a roadmap for resilience. A well-structured ToC should guide not just project impact but also how the impact can be sustained independently by the community after the project cycle.

A strong ToC acknowledges that beneficiaries should not rely indefinitely on one intervention but must transition into self-sustaining models that guarantee long-term benefits.

Case Study: Ripple Effect’s Community-Based Health Financing Model in Migori, Kenya

One example of sustainable programming is Ripple Effect’s project in Migori, Kenya, which integrated livelihood support through sustainable agriculture with a health financing model to ensure long-term community resilience.

1. The Intervention: Agriculture & Health Financing Integration

The project primarily focused on sustainable agriculture to improve household food security and income. However, recognizing that many beneficiaries were affected by HIV/AIDS and struggled with healthcare costs, the program introduced Community-Based Health Financing (CBHF).

This model helped low-income households save and contribute to health insurance schemes to improve access to quality and affordable healthcare, reducing dependency on external funding.

2. Bridging the Gaps in Health Financing

At the time, Kenya’s National Health Insurance Fund (NHIF) was transitioning to the Social Health Authority (SHA), creating uncertainty for vulnerable populations. The CBHF model complemented this transition by providing a community-driven safety net, ensuring that beneficiaries continued to access healthcare services despite system shifts.

3. Why This Model Matters for the USAID-Funded Health Programs

With USAID’s realignment and withdrawal of funding, health projects must ask: What happens when the grants end? Organizations should:

? Reassess their ToC to include sustainability mechanisms—moving beyond short-term aid to long-term, locally managed solutions.

? Integrate community-driven models that empower people to take ownership of their own progress.

? Align with government systems and policies to ensure continuity beyond donor funding.

Lessons for Organizations Navigating the USAID Disruptions

Organizations facing uncertainty in funding can use the following ToC-driven sustainability strategies to build resilience:

1. Design Projects with a Clear Exit Strategy

A sustainable ToC ensures that:

?? Communities are empowered to take over program functions.

?? Support structures (e.g., cooperatives, self-help groups, savings models) are built within the community.

?? Capacity-building efforts strengthen local leadership and ownership.

Example: A USAID-funded maternal health program should not just provide free services but also work with local community health workers, local health insurance schemes, and government systems to ensure services continue beyond donor funding.

2. Build Sustainability Through Community-Led Financing Models

Many USAID-funded health projects have provided free healthcare services to communities. But when the grants stop, the services collapse unless a financial sustainability plan is in place.

?? Introduce community-based health insurance models (e.g., CBHF, VSLA-linked health schemes).

?? Train communities to manage their own pooled health funds.

?? Encourage government partnerships to integrate financing models into national health programs.

Example: A project offering HIV care and treatment can transition beneficiaries into micro-health insurance schemes where they contribute small amounts regularly to sustain their care.

3. Strengthen Local Institutions & Align With Policy Structures

Programs must move away from parallel service delivery and instead work within government frameworks to ensure continuity.

?? Support local clinics and government hospitals to absorb project beneficiaries.

?? Train local health workers to take over program functions.

?? Advocate for policy integration so that donor-supported initiatives become government-backed programs.

Example: community health workers are fully integrated into government health systems, ensuring that services continue regardless of donor presence.

4. Foster Economic Resilience in Communities

Livelihoods are at the core of sustainability—if communities cannot afford services, they remain dependent on external aid.

?? Integrate income-generating activities within health and education programs.

?? Promote savings groups (VSLA, SACCOs) to support ongoing health needs.

?? Encourage youth employment initiatives tied to project outcomes.

Example: A youth empowerment project should not just train youth on employability but also create long-term income pathways, such as enterprise development and job market linkages.

5. Use M&E for Adaptive Learning & Decision-Making

M&E should shift from just reporting outcomes to continuously assessing sustainability gaps and adapting strategies.

?? Conduct post-project sustainability evaluations.

?? Track household resilience indicators (e.g., financial security, service utilization).

?? Monitor how communities are coping with transition periods.

Example: A nutrition project tracking malnutrition rates beyond its lifecycle ensures that communities are equipped with sustainable food security strategies rather than just receiving food aid.

Conclusion: Sustainability Should Not Be an Afterthought

As organizations grapple with USAID’s funding disruptions, the Theory of Change must evolve to ensure communities do not suffer when grants end. Every program—whether in health, livelihoods, or education—must be designed with a built-in exit strategy that enables communities to thrive independently.

?? A project should not be a lifetime dependency—it should walk with beneficiaries for a while and then transition them into self-sufficiency.

?? Organizations must think beyond immediate interventions and focus on what structures remain when the donor exits.

?? Community ownership, government integration, and financial resilience are the pillars of sustainability in development work.